Overview

A very pleasant 21 year old girl with longstanding nasal obstruction and dissatisfaction with her nasal appearance. She had a large left bony septal spur blocking the airway with some mild allergy symptoms too. Aesthetically she had a “tension tip” arrangement with an over projected and broad tip and nasal bridge (hump or fullness) and a boxy tip. She had a straight nose and normal skin.

I performed an open septo-rhinoplasty and coblation turbinoplasty. The procedure involved repurposing some of her septal cartilage (used as grafts) to strengthen and straighten the nose internally as well as reduce and narrow her nasal bridge (using the piezotome which is my routine) and finally reposition and rebuild her tip.

Photos are only 9 months apart so she can expect the very slightest amount of further definition in her nose up to, and a bit beyond, 12 months. Apologies, pre-op photos are not in my main rooms where I have a lighting system to reduce shadowing.

She has had an excellent cosmetic and functional outcome.

Preoperative & post-operative

Overview

Young lady with very thin skin, a crooked nose (significant asymmetry from the base and frontal views), a twisted tip, asymmetrical nostril size and shape, small dorsal (bridge) hump and a deviated septum with very poor nasal airflow. No previous surgery.

Pre and post op 9 months apart.

She had an open septo-rhinoplasty. Quite a complex reconstruction because of her asymmetry and thin, delicate structures. Septal cartilage used for grafts to strengthen and straighten the nose, especially her tip. Alar rim grafts to reposition and hold nostril / alar shape. These also help define the tip. Hump reduced but otherwise minimal bony work on the upper nasal framework. Septum straightened internally.

Still some minor post op nostril asymmetry but patient very happy with result and not interested in further refinement.

Preoperative

Post-operative

Overview

18 year old with a dramatically twisted septum and no effective airway on the right side. Resultant externally crooked nose on frontal and base views.

Pre and post op photos 9 months apart.

Had an open septo-rhinoplasty. The entire septum was removed (extra-corporeal septoplasty) reconstructed and replaced using only the patients own cartilage as grafts for strengthening (I do not use any synthetic implants or supports). The nasal tip was re-supported and the bony nasal bridge reset to the midline. I do all bony work with a piezotome (fine oscillating drill/ saw) as it allows greater control and finesse than traditional chisels and rasping.

Huge improvement in nasal airway.

Preoperative

Post-operative

Overview

Fellow who had previous nasal surgery and nasal trauma. Loss of tip support and collapse of the mid third (saddle nose). Poor airway due to collapse and septal deviation. Apparent hump in profile but actually collapse of the cartilage supports resulting in prominence and exposure of a normal bony bridge.

Pre and post op photos 9 months apart.

Open septo-rhinoplasty with use of what was left of his native septal cartilage for strengthening and support grafts as well as a small portion of ear cartilage to improve the aesthetic of his saddle nose in profile. A resultant better supported and functionally better nose. No bony work was needed. His cartilage framework just needed lifting up and strengthening.

Preoperative

Post-operative

Overview

Gentleman with past history of major facial trauma resulting in nasal deformity, obstruction and an orbital blowout fracture. Had previous nasal and sinus surgery that was unsuccessful. Issues include a combined (bony and cartilaginous) hump in profile, crooked dorsum (bridge) and deviated septum. Poor nasal airway. Mild sinus symptoms and congestion on CT scan.

Photos 13 months apart.

Had a revision open-septo-rhinoplasty and Mini-FESS (Sinus surgery performed endoscopically). Expecting to require rib cartilage but was able to find adequate septal cartilage for support graft to straighten and strengthen his nasal framework. Hump reduced and nose straightened using piezotome.

Preoperative

Post-operative